Case Study 3
Another large county council is exploring the disaggregation of county services into between two and four unitary councils. The below example is provided from the analysis on the four unitary scenario in which the effects of ordinary residence can be seen:
Figure 19: Expected older adults’ nursing demand over time in one local area
In this example, unitaries B and D have less nursing provision available in their geography. As such, today, their nursing demand is often placed in the geographies of unitaries A and D, where there is much more supply. As a result, as LGR goes live, on day 1, B and D will have fewer people supported in nursing care within the authorities. However this will climb as demand originating in B and D will now be placed within these authorities rather than in A and C. Conversely, in unitaries A and C, the number of people supporting in nursing care will gradually decline, as those residents who originated from unitaries B and D pass away, or move on to different care settings. Whilst demand will naturally climb in unitaries A and C as the population ages, this is fully offset by the ordinary residence effect. This illustrates the significant challenges created in scenarios such as this one, with unitaries B and D facing difficult decisions about out of area placements and expanding their own provision. Conversely, A and C may have a surplus of capacity as their demand slowly levels off and drops.
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